Anaesthetics - conduct of anaesthesia

Question 1

What is the role of the anaesthetist

Answer 1

• Pre-operative assessment and care
• Critical care and intensive care
• Administering anaesthesia
  
  • Post-operative care

Question 2

Drugs that can be given on the day of surgery

Answer 2

• All cardiac/ blood pressure except ACEI and AT2 antagonist
• Epilespy/ Parkinson’s drugs
• Asthma drugs
• Gastric acid suppressants (ranitidine, omeprazole
• Thyroid drugs
• Major/ minor tranquillisers/ antidepressants
• Steroids inc inhalers
• Immunosuppressants (azathioprine, tamoxifen)
• Analgesics except NSAIDS

Question 3

Drugs that must be omitted before surgery

Answer 3

• ACEI (veramapil, rampiril)
• Angiotensive 2 antagonists (candesartan)
• Diuretics (furosemide, spironolactone)
• Diabetic medications (must source alternatives)
• Aspirin, clopidogrel, dipyridamole, warfarin
• Non-essential drugs (vitamins, iron, laxatives, antacids, HRT, herbal/homeopathic medications)
• Lithium
  
  • NSAIDS (diclofenac, indomethacin, ibuprofen)

Question 4

Options for induction of anaesthesia

Answer 4

• IV → rapid acting, easy to overdose, apnoea common
• Gas → Slow, common in young children

Question 5

Important factors to consider during anaesthesia induction

Answer 5

• Monitor level of consciousness → verbal contact, movement, respiratory pattern, EEG
• Maintenance of airways
  
  • Triple airway manoeuvre
  • Simple mask

Question 6

Define the anaesthetic face mask

Answer 6

• Same as those used in rhesus
• Contoured to face → allows for gas-high seal
• Varied sizes for neonates and adults
  *

Question 7

Define the oropharyngeal airway

Answer 7

• AKA Guedel
• Rigid plastic tube inserted into airways
• Only tolerated in unconscious patients

Question 8

Define the laryngeal mask airway

Answer 8

• Cuffed tube that sits over glottis
• Used in rhesus

Question 9

Airway complications during induction of anaesthesia

Answer 9

• Obstruction
  
  • Ineffective triple airway manœuvre
  • Airway Device malposition/ kinking
  • Laryngospasm
• Aspiration
  
  • Loss of protective airway reflexes
  • Foreign material in lower airway

Question 10

Define the endotracheal tube

Answer 10

• Cuffed tube placed in trachea
  
  • Protects airways from contamination/ aspiration

Question 11

Why intubate

Answer 11

• Emergency patients → protects airway from gastric content
• Laparatomy → muscle relaxant and artificial ventilation
• Tonsilletomy → risk of airway blood contamination
• Neurosurgery → tight blood gas control
• Max fax → restricted access to airway

Question 12

Risk to an unconscious patient

Answer 12

• Airways, airways, airways
• Temperature
• Loss of protective reflexes → corneal joint position,
• VTE
• Consent and identification
• Pressure areas

Question 13

What is the role of the anaesthetist during surgery

Answer 13

• Care of the unconscious patient
• Muscle relaxation, analgesia
• Monitoring and physiological support
• Fluid management
  
  • Documentation and recording

Question 14

Minimum components that need to be monitored whilst patient is unconscious

Answer 14

• Oxygen saturation
• ECG
• Non-invasive blood pressure
• Fraction inspired oxygen
• Fraction of exhaled CO2
• Respiratory parameters
• Agent monitoring
• Temperature, urine output, NMJ
• Venous/ arterial monitoring
  
  • Ventilator disconnection

Question 15

What occurs during awakening from anaesthetics

Answer 15

• Muscle relaxant reversal
• Anaesthetic agent reversal
• Resumption of spontaneous respiration
• Return of airway reflexes/ control
• Extubation
• Speed of awakening varies

Question 16

Aspects involved in recovery from anaesthesia

Answer 16

• Airway control in those who haven’t regained consciousness
• Continued care of the anaesthetist
• Pain control
• Manage post-operative nausea